By the end of 2009, the Centers for Disease Control and Prevention (CDC) reported that there was an estimated total of 3,040 American Indian/Alaska Native (AI/AN) people living with HIV. It was also reported that the number of new HIV infections among AI/AN people had increased by 8.7 percent between 2007 and 2010 – the greatest percent increase when compared to other races/ethnicities.
To better understand the possible reasons behind the increase, it is important to consider two points.
First, as Natives, we struggle with data that attempts to group all tribal groups into one population. Tribes are sovereign and therefore each tribal nation owns its data. Some choose not to share data with the states that report to the CDC. Although there are sound historical reasons for this, the result is multiple data sources that are never merged, such as tribes who manage their own health services, Indian Health Service data and state data. With this in mind, it is certain that most HIV/AIDS data for AI/AN is inaccurate and equally likely that the prevalence statistics are underreported. Funding follows data and when we are bound by statistics that underreport our situation, funding for Natives remains limited.
A second important point is that the numbers for those testing positive appear to have increased due to a general awareness in Native communities that HIV does exist in our people and that we must pay attention.
More and more, we encounter traditional Native groups who have now initiated HIV testing and prevention as well as urban groups who have increased and expanded testing opportunities. National Native HIV/AIDS Awareness Day also may have contributed to this increase. It was launched in 2007 by Commitment to Action for 7th Generation Awareness and Education (CA7AE), Intertribal Council of Arizona (ITCA) and the National Native American AIDS Prevention Center (NNAAPC). Perhaps the silver lining here is that with more awareness comes the opportunity to teach communities the intervention techniques to reduce and eliminate HIV/AIDS. Work by CA7AE provides examples of such efforts.
Funded by the CDC, CA7AE works with Native communities to help them build technical capacity to use the Community Readiness Model, a tool developed at Colorado State University. It provides a tool with which to help communities develop and implement prevention and intervention efforts in line with their readiness level and their specific culture. The model is effective for sensitive social issues because it integrates the culture of the community and uses community input. For its success, it has received national and international recognition.
In 2009, the Office of Minority Health Resource Center offered funding aimed at increasing testing efforts in Native communities and one of these grantees, the Choctaw Nation of Oklahoma (CNO), requested assistance from CA7AE in utilizing the Community Readiness Model in all of their 11 counties.
The model proved effective despite the fact that each county was different in demographics, access to services and other factors. The tool allowed each county to utilize their own unique readiness score to develop appropriate strategies. Counties that were not quite ready to address HIV were ready to address related issues such as sexually transmitted infections and/or hepatitis, and HIV became a part of that education.
"Our work with CA7AE has been transformative for our communities," said Kari Hearod, Director of Behavioral Health. "As a health system, we made the assumption that our communities were not ready to talk about HIV. Through use of the Community Readiness Model, we discovered that not only were our communities ready to talk, they were also ready to take action. If we had not listened to what the communities had to say we would still be operating under mistaken assumptions, and missing vital opportunities.
"We are now conducting HIV 101 presentations in our communities and with staff across the CNO," Hearod said. "It really proved to us that you always have to listen to the community voice. This is really the only path to lasting and positive change."
Pamela Jumper Thurman, Ph.D., a Western Cherokee, is a Senior Research Scientist and Director of the National Center for Community Readiness and the CA7AE Project at Colorado State University. She is one of the primary developers of the Community Readiness Model and has applied it in over 3,500 communities throughout the United States as well as over 33 countries internationally.
Barbara Plested, Ph.D,. is a Research Scientist and Co-Director of the National Center for Community Readiness and the CA7AE Project at Colorado State University, Ft. Collins, Colorado. She serves as an evaluator and grant writer for American Indian programs and is also one of the primary developers of the Community Readiness model and has applied both nationally and internationally.